A 2-month-old girl is brought to the office for a follow-up examination. The parents are concerned about a red bump that first appeared on her scalp at age 3 weeks. The lesion has since grown significantly in size. The child's growth and development are appropriate for age. A photograph of the lesion is shown in the exhibit.
Examination shows no other abnormalities. This child's lesion is most likely primarily composed of which of the following?

Question

A 2-month-old girl is brought to the office for a follow-up examination.  The parents are concerned about a red bump that first appeared on her scalp at age 3 weeks.  The lesion has since grown significantly in size.  The child's growth and development are appropriate for age.  A photograph of the lesion is shown in the exhibit.  
Examination shows no other abnormalities.  This child's lesion is most likely primarily composed of which of the following?

Quizplus · Accepted Answer

11ec160b_38f6_4e67_9249_915268ec14da_MD0001_00 This patient's rapidly growing lesion is consistent with an infantile hemangioma, a common, benign vascular tumor characterized by neoplastic proliferation of endothelial cells. Infantile hemangiomas occur most often on the head or neck. They present within weeks of birth as a solitary red papule or nodule. The lesion shows characteristic rapid growth for several months followed by spontaneous, gradual regression over several years. Growth of infantile hemangiomas is thought to be related to the de novo production of a vascular network (ie, vasculogenesis) and/or the sprouting of new blood vessels from existing ones (ie, angiogenesis). Microscopic examination during the growth phase shows multiple lobules of densely packed capillaries lined by plump endothelium. As the lesion regresses, the endothelial cells undergo apoptosis, and the capillaries are replaced by fibrofatty tissue. (Choice A) Enchondroma and chondrosarcoma are examples of cartilage-forming neoplasms. Enchondromas are benign and commonly involve the bones of the hands and feet. Chondrosarcomas are malignant lesions that usually involve the axial skeleton of older adults. (Choice C) Merkel cell carcinoma is a rare, cutaneous tumor of neuroendocrine cell origin that presents as a rapidly expanding, firm, pink nodule. This condition is nearly exclusive to older adults. (Choice D) Leiomyoma (benign) and leiomyosarcoma (malignant) are smooth muscle neoplasms most commonly found in the genitourinary (eg, uterus) or gastrointestinal tract. Lesions can involve the skin but present as small, painful nodules. In addition, these tumors are exceedingly rare in young children and do not grow rapidly. (Choice E) Squamous epithelial cells may give rise to squamous cell carcinoma, which, in contrast to this case, appears as an ulcerated or hyperkeratotic plaque in adults with sun-damaged skin. Educational objective: Infantile hemangiomas are benign vascular tumors composed of proliferating endothelial cells that most frequently affect the head or neck region. Natural history of these lesions involves rapid growth of a red, cutaneous plaque followed by spontaneous regression. __________ References: Hemangioma. (http://www.ncbi.nlm.nih.gov/pubmed/30855820)

A 2-Month-Old Girl Is Brought to the Office for a Follow-Up